| NPI | 1386077170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: MD 630107010427145) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: MD MT11754) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |